Chapter 7: Learning IV Medications Flashcards
Another name for a venous catheter
Line
Where is a common vein where a peripheral catheter can be inserted?
cephalic vein in the arm
What is a limitation of administering drugs into smaller veins?
Phlebitis (vein irritation), venous thrombosis and fluid extravasation
Where does a central line empty into?
larger veins
Central lines provide secure, long-term vascular access and are required for administration of:
- highly concentrated drugs
- long term antibiotics
- toxic drugs that can cause phlebitis (e.g. chemo)
- drugs with a pH or osmolality that is not close to blood pH or osmolality (e.g. parenteral nutrition)
Where can central lines be placed?
- Into a large vessel like the superior vena cava
- Into a smaller vein and advancing the catheter through the vein until the tip ends in the superior vena cava (called a PICC - peripherally inserted central catheter)
What are examples of common vesicants
- Vasopressors (dopamine, NE)
- Anthracyclines (e.g. doxorubicin)
- Vinca alkaloids (e.g. vincristine)
- Promethazine
Name 3 primary compatibility and stability sources for parenteral medications
- Trissel’s Handbook on Injectable Drugs
- King guide to Parenteral Admixtures
- Package insert
type of incompatabilities and examples
chemical: hydrolysis, oxidation, or decompensation
physical: the conainter (PVC), diluent (Dextrose or saline), another drug
Drugs that have leaching or adsorption/absorption issues with PCV containers can be placed in:
Polyolefin, polypropylene or glass containers (these are known as non-PVC containers)
Key drugs with leaching/adsorption/absorption issues with PVC containers
- Lorazepam
- Amiodarone
- Tacrolimus
- Taxanes
- Insulin
- Nitroglycerin
Remember: LATTIN
when people “LATTIN” dance they are very close and adsorb to each other
What are key drugs that cannot be put into dextrose & can only be used with saline?
- Daptomycin (cubicin)
- Infliximab (Remicade)
- Ampicillin
- Phenytoin (Dilantin)
- Ampicillin/sulbactam (Unasyn)
- Caspofungin (Cancidas)
- Ertapenem (Invanz)
Remember: DIAPACE
diabetics need to pace themselves with sugar so they have salt instead
also diabetics get a lot of infections so most of these are anti-infectives
What are key drugs that cannot be put into saline & can only be used with dextrose?
- Bactrim
- Oxaliplatin
- Amphotericin B
- Synercid (Quinupristin/Dalfopristin)
Remember: BOAS will strangle the pharmacist who puts these drugs into anything but dextrose
What are two examples of high-risk incompatibilities?
- Ceftriaxone and any calcium-containing solutions due to risk of precipitates (e.g. lactated ringers contains calcium and cannot be mixed with ceftriaxone)
- Calcium and phosphate
precipitates can lead to emboli
What is a 1.2 micron filter used for?
Lipids
what drug needs a 5 micron filter?
ampho B
What size filter should you use for parenteral nutrition?
0.22 micron filter, which will catch calcium-phosphate particulates
what size filter do most filtered medications need?
0.22 micron filter
What are common drugs with filter requirements?
- Golimumab
- Amiodarone
- Lorazepam (when administered by continuous infusion)
- Phenytoin (when administered by continuous infusion)
- Lipids (1.2 micron)
- Amphotericin B (lipid formulations; use 5 micron filter)
- Taxanes (except docetaxel)
Remember: That’s my GAL, PLAT or GALLTAP
Which key IV drugs crystalize if kept cold and are stored at room temperature?
- Dexmedetomidine (Precedex)
- Phenytoin (crystalizes)
- Bactrim (Sulfamethoxazole/Trimethoprim)
- Furosemide (crystalizes)
- Metronidazole
- Moxifloxacin (Avelox)
- Enoxaparin (Lovenox)
Remember: Dear Pharmacist, Being Frigid Makes Me Edgy
What are key drugs that must be protected from light during administration?
- Phytonadione (Vitamin K; Mephyton)
- Epoprostenol (Flolan)
- Nitroprusside (Nitropress)
- Micafungin (Mycamine)
- Doxycycline
Remember: Protect Every Necessary Med from Daylight
Or PM DEN
Which drugs are easily destroyed if shaken/agitated?
- Albumin
- Alteplase
- Immune globulins
- Insulins
- Etanercept
- Monoclonal antibodies
- Rasburicase
- Some vaccines, including zoster
Mostly proteins and hormones
In most cases, discoloration of a drug indicates ___ or ___
Oxidation
decompensation
Oxidation of dobutamine turns the solution slightly ____
Is potency lost?
Pink
no
